IRcctal  Conbtttous 


EtTGENE    P.   HOYT,   M,    D. 


LONDON 


m^M^^!^w:^M 


ACsr>'<3 


Columbia  (Hnitiewttj) 

mtljeCttpoflmitork 

CoUege  of  l^f^v^itiana  mh  burgeons! 


I 


IRectal  Conbitions 


EUGENE   E.    HOYT,   M.  D 


NKW  YORK 

A.ND 

LONDON 


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preface. 


^U  have  come  to  the  conclusion  that  nobody  abuses 
another,  unless  he  fears  him  or  envies  him,'" 


When  I  have  completed  my  thirty -sixth  year  in  this 
specialty^  and  that  wont  take  long  now — /  am  going 
to  retire.  I  am  sending  out  a  few  farewell  lines,  not  for 
the  purpose  of  self-exploitation,  as  I  passed  that  neces- 
sity many  years  ago — hut  to  offer  a  suggestion  and  in- 
ducement that  may  lead  many  younger  men  to  adopt  this 
line  of  practice.  There  are  about  one  hundred  bright 
physicians  in  this  city  to-day  that  are  just  thirty  years 
old  that  could  not  do  better  than  to  follow  this  outlook. 
With  one  hundred  in  the  fields  all  well  equipped  and 
honest,  the  subject  would  be  so  popularised  that  it  could 
not  fail  to  command  the  patronage  of  that  2ofo  of  all  the 
people  that  are  suffering  from  something  of  this  kind.  No 
one  reputation  can  compass  but  a  small  portion  of  this  in- 
valid class,  but  a  united  array  of  masterful  talent  could 
so  impress  its  stamp  of  superiority  upon  this  invalid  world, 
that  a  general  and  popular  support  could  not  fail  to  be 
the  outcome.  Of  course  no  one  can  be  infallible,  but  ap- 
proximations express  the  relative  difference  between  dif- 
ferent individuals.  The  compensations  both  as  to  money 
and  gratitude  are  greater  than  in  any  other  form  of 
practice,  because  more  can  be  done  to  quicken  that  sense 
of  appreciation  which  always  speaks  the  language  of  true 
equivalents. 


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IRectal  Conbitions 


WITHOUT  in  the  least  indulging  in  the  luxury 
of  conjecture,  I  shall  endeavor  to  outline  a 
measure  of  intuition,  because  intuition  is  the 
refinement  of  practical  knowledge.  In  the  absolute 
this  is  quite  impossible,  for  the  full  fruition  of  an 
expert  experience  can  never  be  translated  into  a  con- 
cise exposition  of  any  subject,  as  every  student  and 
every  philosopher  must  build  their  own  watchwords. 
To  a  certain  extent  this  is  dangerous  business.  Any 
one  having  traveled  on  a  synthetic  train  for  over  thirty 
years,  catalogued  every  danger  signal,  eliminated 
every  possible  disaster,  it  is  hardly  reasonable  to  expect 
that  a  man  of  incoherent  qualifications  can  fly  in  the 
face  of  such  an  equipment  without  becoming  more  or 
less  confused  as  to  his  comprehension  of  such  specified 
conditions.  Consequently,  there  ensues  adverse  opin- 
ions and  disappointments,  because  of  the  want  of  parity 
between  the  man  and  the  undertaking. 

Frequently  there  goes  floating  on  the  ocean  of  peri- 
odical literature  a  sharp  criticism,  condemning  some 
surgical  proposition — sitting  in  judgment  upon  an  idea 
because  of  the  insufficiency  of  an  individual.  As  ex- 
perience is  the  only  safe  standard  of  judgment,  it  is 
surely  unwise  to  embrace  an  opinion  gathered  from 
an  array  of  head-lines  that  denote  the  doings  of  those 
devoid  of  experience.     This  may  seem  a  little  emo- 


tional,  but  it  arises  from  a  lurid  conviction  that  this 
subject  has  been  greatly  neglected  by  the  general  phy- 
sician, thereby  overlooking  a  world  of  disturbing  influ- 
ences that  send  such  wicked  messages  all  along  the 
many  highw^ays  of  human  feeling. 

It  is  a  well-knozvn  fact  that  there  are  a  greater  num- 
ber of  years  stolen  from  human  lives  by  the  persistent 
robbery  of  Rectal  disea^ses  than  by  any  other  influence. 
This  explains  why  so  many  pernicious  preparations  are 
Hooding  the  market,  alleging  to  cover  these  conditions, 
because  the  general  public  has  not  found  satisfaction 
in  the  legitimate  medical  world.  I  have  operated  upon 
hundreds  and  hundreds  of  Fistula  cases,  by  every 
known  method,  all  the  time  sifting  and  thinking  and 
eliminating  and  qualifying,  hoping  to  arrive  at  some 
reliable  standard  by  which  this  dreaded  condition  could 
be  rescued  from  the  bondage  of  so  many  painful  and 
enervating  details.  The  fact  that  there  are  so  many 
ways  of  accomplishing  the  same  purpose  proves  that 
the  subject  does  not  carry  any  harmony  of  thought,  any 
perfect  and  uniform  prospect  that  can  lend  a  sense  of 
comfort  and  peace  to  the  unfortunate  sufferers,  in  view 
of  which  there  naturally  arises.  What  is  the  answer? 

As  an  expression  of  simplicity  and  success,  the  an- 
swer is  as  follows :  To  divide  the  wall  over  the  sinus 
is  imperative — any  suggestion  at  variance  with  this 
idea  is  trifling  with  a  sacred  responsibility.  Inject  co- 
caine so  as  to  get  its  effect  for  about  one  inch  parallel 
to  the  outer  extremity  of  the  fistula;  then  introduce 
the  grooved  director,  after  which  divide  the  tissue  so 
affected ;  then  with  a  double  bulbed  atomizer,  filled 
with  electrozone,  throw  a  continued  spray  into  the 
wound  for  one  minute,  holding  the  nozzle  about  four 
inches  away  so  as  to  reduce  the  force  of  impact.  There 
is  something  peculiar  and  very  satisfactory  in  the 
action  of  this  antiseptic,  as  it  renders  the  parts  free 
from  that  sensitive  soreness  that  naturally  would  be 


expected,  allowing  the  patient  to  continue  his  daily 
avocation  without  inconvenience.  The  first  dressing 
after  incision  consists  of  packing  firmly  with  iodoform 
gauze  covered  with  antiseptic  cotton  and  held  in  posi- 
tion by  a  T  bandage.  In  about  every  three  to  ten  days 
an  inch  can  be  divided,  and  so  on  until  the  inner  end 
is  reached.  //  there  are  any  branches  they  always  show 
themselves,  as  their  point  of  departure  from  the  central 
track  refuses  to  heal  with  the  general  result;  so  it  is 
impossible  to  overlook  any  diverging  issue. 

It  is  interesting  to  note  how  about  three  minutes' 
daily  attention  can  secure  such  prompt  resolution  in 
these  cases,  the  patient  being  lifted  out  of  a  depressed 
relation  in  a  manner  that  gives  prompt  buoyancy  to 
their  feelings,  simply  because  all  septicemic  poisoning 
has  been  discontinued.  There  is  always  a  gain  in 
weight  from  the  beginning.  In  hospital  methods, 
which  have  the  sanction  of  the  entire  surgical  world, 
these  cases  are  frequently  operated  upon  several  times, 
each  event  repeating  the  usual  details  of  anesthetics 
and  confinement.  The  reason  of  this  is  found  in  the 
eccentric  and  complex  windings  of  numerous  tracks 
with  only  a  central  one  presenting  an  objective  exist- 
ence. Collateral  to  this  main  issue  there  may  slumber 
several  connecting  branches,  either  circling  the  entire 
rectum  or  extending  in  any  direction,  a  veritable  con- 
flux of  pathological  surprises.  /  defy  any  man  to 
diagnose  in  full  completeness  the  entire  compass  of  one 
of  these  cases  before  or  at  time  of  operation.  Some- 
times there  are  several  distinct  tracks,  having  all  their 
internal  and  external  terminations  at  a  common  junc- 
ture with  all  the  evidence  of  existence  resting  with  the 
one  closest  to  the  surface.  Through  this  one  the  surgeon 
goes  with  every  reason  for  a  favorable  prognosis ;  but 
in  a  brief  time  one  of  these  other  companions,  having 
inherited  the  responsibility  that  heretofore  fell  upon  its 
destroyed  associate,  now  awakens  into  activity  and  de- 


mands  recognition.  By  treating  these  cases  in  sections 
as  intimated,  nothing  of  this  kind  can  occur,  as  the 
whole  combination  falls  within  easy  range  of  the  central 
idea,  and  when  once  the  result  has  been  attained  it 
remains  a  permanent  reality,  barring  only  those  inci- 
dents that  relate  to  every  human  being. 

When  a  man's  whole  kingdom  consists  in  what  he 
does,  he  is  always  anxious  to  do  it  well.  Even  the 
purblind  charaltan  would  bow  to  the  most  exacting 
penalty  if  he  could  only  do  as  well  a^  he  pretends,  I 
do  not  know  of  higher  flights  of  feeling  as  a  reward  of 
doing  well,  than  that  vortex  of  gratitude  and  apprecia- 
tion that  comes  from  the  individual  who  has  been  bodily 
lifted  out  of  a  fistulous  bondage  in  a  manner  that  has 
obviated  all  those  experiences  usual  in  such  cases; 
besides,  it  is  a  very  agreeable  emotion  to  throw  an  olive 
branch  to  that  strain  of  tragedy  that  runs  through  the 
temperament  of  every  human  being. 

It  is  probably  true  that  cocaine  has  never  been  sug- 
gested as  a  means  of  healing  those  anatomical  breaks 
that  thrive  upon  the  mobility  of  the  sphincter  muscle. 
All  incipient  fissures  and  allied  conditions  that  refuse 
granulation  can  be  brought  to  a  prompt  and  successful 
issue  by  injecting  once  daily  a  few  drops  of  the  4  per 
cent,  solution  at  right  angles  just  through  the  floor 
of  the  difficulty.  This  holds  the  parts  to  a  passive 
career  until  the  next  movement,  when  it  should  be 
repeated,  and  in  a  few  days  only  the  resolution  will  be 
complete,  saving  the  necessity  of  dilatation,  which  is 
the  standard  method  of  treating  these  affairs.  It  will 
also  remedy  those  old  organic  fissures,  controlling  the 
pain  at  once ;  but  in  such  cases  the  muscles  have  become 
hypertrophied,  creating  mechanical  constipation  and  a 
wonderful  wilderness  of  reflex  symptoms  that  demand 
divulsion. 


STRETCHING    THE    SPHINCTER    MUSCLE  ! 

How  I  wish  I  possessed  sufficient  command  of  lan- 
guage to  paint  in  graphic  colors  all  that  is  true  regard- 
ing the  beneficence  of  this  apparently  simple  device. 
When  this  muscle  loses  its  ordination,  what  a  field  of 
wickedness  does  it  create !  I  have  seen  thousands  of 
people  locked  in  the  grasp  of  its  misbehavior,  every 
moment  seemingly  the  last  one  that  could  be  endured, 
just  because  a  slight  rupture  of  continuity  created  a 
reflex  activity  and  threw  the  entire  rectum  into  a  spasm. 

There  are  a  multitude  of  distributed  discords  that 
picture  a  more  passive  expression  of  reflex  actions, 
playing  facsimile  to  the  entire  pathogenesis  of  every 
known  remedy,  completely  stranding  the  pure  symp- 
tomatologist  who  finds  that  this  complex  a/rray  of 
indications  refuse  to  abdicate  at  the  instance  of  his 
medicine,  while  the  patient  becomes  demoralized  in 
disposition,  and  yields  to  a  paralysis  of  hope — so  de- 
pressing are  these  migratory  influences.  And  yet,  just 
a  little  skill  in  the  direction  of  a  peripheral  inquiry 
would  promptly  solve  the  subtle  mystery. 

Divulsion  for  constipation  exclusively  is  very  seldom 
indicated;  but  when  the  conditions  correspond  to  a 
well-defined  adaptability,  then  the  result  is  most  beau- 
tiful. These  cases  usually  are  women  of  high  nervous 
tension,  whose  original  moulds  of  temperament  were 
seemingly  decoyed  from  destiny  by  some  adventitious 
circumstance,  whose  dispositions  play  the  entire  range 
upon  the  keyboard  of  fluctuating  humor, — either  very 
happy  or  very  mad,  but  supremely  emphatic  at  either 
extreme.  Upon  examination  there  will  be  found  a  slim 
spasmodic  sphincter  muscle,  with  its  correlative  con- 
dition of  general  engorgement,  obstinate  constipation 
attended  with  great  exhaustion  after  each  movement, 
owing  to  the  excessive  nervous  combustion,  referable 
both  to  the  type  of  woman  and  the  discord  discovered. 


The  slightest  effort  to  exercise  any  extrusive  energy- 
will  cause  the  muscle  to  spasmodically  contract,  com- 
pletely locking  the  function.  In  one  minute  these  cases 
can  be  restored  by  stretching  the  sphincter.  It  must 
be  thoroughly  realized,  that  because  this  idea  is  so 
successful  in  given  instances,  it  does  not  follow  that 
every  case  of  this  complaint  can  be  similarly  overcome. 
Differentiation  is  the  religion  of  this  specialty,  and  no 
surgical  theory  can  become  a  surgical  fact  without  an 
infinity  of  successful  repetitions. 

It  is  an  almost  inevitable  sequence — a  fistula  follow- 
ing an  abscess — because  of  the  everlasting  mobility  of 
the  parts,  both  from  the  function  and  the  compound 
action  of  the  sphincter  muscles.  Whenever  the  genesis 
of  one  of  these  events  comes  under  consideration,  it  is 
quite  easy  to  close  the  affair  without  the  fistulous 
consequence,  allowing  the  physician  to  round  out  the 
experience  with  a  vast  amount  of  mutual  satisfaction. 
Coincident  with  the  opening  of  the  abscess  dilate  the 
muscle  thoroughly,  and  the  region  becomes  a  passive 
location  amenable  to  all  those  repairing  influences 
referable  to  rest  and  local  stimulations.  The  only 
trouble  with  these  cases  is,  the  physician  is  not  usually 
consulted  until  that  specific  sinus  has  become  a  living 
issue. 

Strangulated  hemorrhoids  mean  ten  days  in  bed 
under  influences  that  tend  to  allay  pain  and  absorb 
the  effusion,  unless  they  can  be  promptly  returned. 
When  they  have  become  fixed  in  an  external  relation 
and  refuse  to  be  conciliated, — locked  out,  as  it  were, 
by  the  agency  of  a  spasmodic  grasp, — then  under  an 
anesthetic  push  the  entire  mass  back  into  place,  dilate 
the  rectum  to  insure  a  quiet  behavior,  support  with  a 
firm  compress,  and  in  twenty-four  hours  the  patient 
can  go  his  way  unmindful  of  recent  events,  saving  a 
week  in  time  both  as  to  pain  and  business.  This  refers 
strictly  and  exclusively  to  a  protrusion  of  hemorrhoidal 


growths  and  not  to  that  marginal  circular  effusion  into 
cellular  tissue  that  is  so  often  mistaken  for  inflamed 
hemorrhoids. 

There  are  a  great  many  people  suffering  from  a 
peripheral  poverty,  even  to  the  extent  of  finger  nails 
wasting  from  inanition,  just  because  the  circulation 
fails  to  reach  the  capillary  frontier,  being  held  in  in- 
sufficiency by  a  Rectal  obstruction  of  some  specific 
nature.  When  the  blockade  has  been  overcome  then 
the  cutaneous  nourishment  becomes  re-established  with 
all  of  its  auxiliary  details,  giving  longer  life  and  im- 
proved personality  to  the  individual.  These  particular 
instances  are  profusely  provocative  of  mistakes  by  the 
general  practitioner,  because  he  only  considers  the 
objective  outcome,  letting  the  central  storm  centre  go 
on  undisturbed,  daily  lowering  the  vitality  and  leading 
to  premature  dissolution. 

In  the  above  brief  examples  can  be  found  the  range 
of  adaptability  suited  to  rectal  dilatation,  and  hov/ 
swiftly  the  comprehension  can  measure  the  benefits 
of  this  wonderful  service.  There  is  nothing  left  to 
contingency,  no  fluctuating  quotations  of  hope,  no 
unsolved  puzzle  that  has  to  be  gone  over  the  second 
time — it  is  all  in  the  grasp  of  one  word,  compatibility 
— and  quicker  than  arithmetic  arrives  the  satisfactory 
result.  A  large  portion  of  my  reputation  has  been 
built  upon  the  prompt  and  material  benefits  resulting 
from  the  correct  application  of  divulsion,  so  deep  and 
lasting  is  the  spirit  of  appreciation  that  springs  into 
activity  out  of  the  responsive  senses  of  every  patient 
so  quickly  restored.  Yet  there  has  been  a  vast  amount 
of  harm  engendered  by  the  wholesale  and  haphazard 
use  of  this  idea  by  those  who  seem  to  forget  that  judg- 
ment must  be  exercised  in  every  individual  instance 
and  not  let  one  conclusion  stand  sponsor  for  the  multi- 
tude. There  are  also  those,  in  the  spirit  of  fanaticism, 
that  pronounce  nearly  every  phase  of  pathology  as  the 


reflex  result  of  some  orificial  disturbance,  teaching  that 
nearly  all  diseases  can  be  overcome  through  the  agency 
of  some  local  repair ;  but  most  every  one  prefers  a  well- 
balanced  mind  that  deals  in  reason  to  one  that  evolves 
such  lurid  imaginations — for  imagination  when  given 
unbridled  liberty  becomes  a  most  dangerous  adventurer. 

In  dilating  the  rectum,  place  the  patient  on  left  side 
close  to  edge  of  the  bed,  with  limbs  flexed  firmly  upon 
the  abdomen.  An  assistant  gives  the  anesthetic — 
nitrous  oxide  is  the  best,  easiest  and  quickest,  one  min- 
ute being  time  enough,  including  the  operation.  With 
ether  it  is  different.  Then  introducing  the  thumb  of 
the  right  hand  very  slowly — if  it  is  not  done  slowly  an 
unconscious  mobility  is  aroused  that  extends  the  limbs 
and  interrupts  the  proceeding.  Follow  this  with  the 
index  finger  of  the  left  hand,  and  the  entire  situation  is 
under  complete  command.  Begin  with  slight  traction, 
so  as  to  measure  the  resistance,  as  no  two  cases  are 
alike — a  certain  force  necessary  in  one  would  be  ruin 
in  another.  Continue  until  the  entire  muscle  has  lost 
all  its  power  of  competition,  alternating  the  applied 
force  several  times  with  complete  cessation,  so  as  to 
give  a  kneading  conciliating  motion  to  the  entire  event. 
Never  use  a  speculum,  as  a  machine  does  not  have  any 
intelligence,  and  so  many  people  have  been  fastened  to 
a  lifelong  calamity  by  the  incompetence  of  this  idea. 
With  a  little  experience  any  one  can  get  an  educated 
touch  that  will  become  automatic,  insuring  a  perfect 
result  in  every  instance. 

Rectal  apoplexy  yields  an  opportunity  for  making 
great  and  favorable  impressions — away  beyond  the 
measure  of  importance  the  condition  implies.  By  some 
mechanical  circumstance  a  small  vessel  becomes  rup- 
tured, pouring  its  contents  out  into  the  adjacent  tissue, 
and  coagulates.  To  the  touch  comes  the  indication  of 
a  small,  hard  foreign  substance.  Inject  cocaine,  open 
the  pocket  and  out  comes  the  clot,  to  the  great  delight 

10 


of  the  patient,  because  he  always  has  a  sudden  fear  of 
dangerous  complications,  as  the  whole  affair  may 
develop  in  an  hour. 


In  1874  I  accidentally  encountered  the  original  idea 
of  destroying  hemorrhoidal  tissue  by  an  interstitial 
diffusion  of  carbolic  acid.  At  once  I  began  the  prose- 
cution of  the  problem,  always  conservative,  always 
persistent,  and  always  flushed  with  great  confidence  as 
to  the  ultimate  outcome  of  the  fascinating  proposition. 
Little  by  little  the  units  of  merit  were  unfolded  and 
classified,  expanding  here  and  restricting  there,  making 
permanent  such  factors  as  stood  endless  repetitions  of 
success.  /  never  vaulted  into  wayward  conclusions  on 
the  impulse  of  insuificient  evidence,  hut  charged  every 
fracture  of  expectation  to  the  personal  account  of  un- 
developed skill,  and  proceeded  to  build  in  by  practical 
thought  and  practical  execution  good  solid  material  in 
the  place  of  such  laggard  fragments  as  refused  to 
round  out  info  a  harmony  of  perfect  result. 

When  confronted  with  any  one  that  says  he  has  a 
hemorrhoidal  condition,  in  nine  cases  out  of  ten  he  does 
not  have  anything  of  the  kind,  because  there  seems  to 
be  an  organized  understanding  to  call  every  Rectal 
condition  by  this  one  name.  When  he  tells  you  of  a 
prolapsus  at  every  action  it  may  be  one  of  several 
different  affairs,  and  it  is  imperative  that  the  diagnosis 
be  correctly  made  at  once.  I  always  inject  an  anti- 
septic saline  solution  and  allow  the  patient  to  force  it 
all  away,  when  the  prolapsus  brings  into  view  the  true 
character  of  the  case. 

Carbolic  acid  is  such  a  chaste  remedy,  truly  typical 
of  all  the  virtues,  and  stands  seemingly  foreordained 
as  an  agent  thoroughly  qualified  to  answer  for  the 
perfect  annihilation  of  all  those  hemorrhoidal  growths 
that  represent  an  anastomosis  of  blood  vessels.  All 
other  types  are  outside  the  range  of  this  treatment, 

11 


and  right  at  this  point  emanates  the  battle  cry  of  dis- 
appointment, simply  because  an  undeveloped  judgment 
wanders  beyond  the  boundary  lines  of  its  own  jurisdic- 
tion. A  10  per  cent,  solution,  thrown  very  slowly  and 
very  sparingly  into  the  living  hemorrhoidal  tissue, 
becomes  at  once  thoroughly  distributed,  entering  into 
an  intimate  relation  with  every  unit  of  the  structure, 
coagulating  just  enough  albumen  to  interrupt  nutrition, 
practically  choking  the  tumor  out  of  existence.  This 
may  have  to  be  repeated  once  or  twice,  but  the  rectal 
surfaces  are  always  restored  to  their  normal  condition 
without  leaving  any  indication  of  a  pathological  his- 
tory. When  the  recovery  has  advanced,  so  there  is  no 
more  protrusion  under  any  circumstances,  it  is  not  safe 
to  discontinue,  for  a  considerable  portion  remains  that 
is  never  observed  from  the  outside.  By  means  of  a 
slide  speculum,  the  entire  field  should  be  cleared  of  all 
remnants,  dealing  with  the  tissue  while  insinuated  in 
the  fenestrum.  This  all  looks  very  easy,  but  it  is  not, 
because  the  intellect  has  to  experience  the  most  com- 
plex activities  in  order  to  give  expression  to  this 
masterly  simplicity.  I  can  say  with  absolute  confidence, 
regarding  this  system,  that  admiration  will  always  wait 
upon  acquaintance  with  perfect  compatibility,  though 
great  stress  must  be  placed  upon  the  fact  that  the  word 
''acquaintance"  is  wonderfully  relative. 

The  war  cry  of  danger,  coming  from  undefined 
directions,  has  found  some  currency  along  the  lines  of 
monthly  literature,  but  it  does  not  rise  to  the  dignity 
of  authority,  because  it  is  the  outcome  of  collected 
quotations  either  from  nondescript  practitioners  or 
those  that  have  only  made  a  desultory  investigation  of 
the  subject.  What  I  have  to  offer  is  founded  upon 
thirty  thousand  successful  cases  covering  the  entire 
half  of  a  long  lifetime,  which  proves  that  what  is 
chimerical  in  the  eyes  of  opinion  may  become  a  well- 
defined   reality   through   the   medium   of   experience. 

12 


One  writer  exclaims  that  his  investigation  consisted  in 
throwing  five  drops  of  a  50  per  cent,  solution  into  the 
center  of  the  tumor,  then  waiting  for  the  commotion. 
He  was  wise  to  abandon  the  idea.  He  makes  me  think 
of  a  man  playing  billiards  without  skill,  just  hitting 
the  object  ball  with  all  his  force,  then  watching  the 
result.  Sometimes  he  really  makes  a  count,  but  never 
becomes  an  authority  in  billiards.  A  judgment  founded 
upon  the  alphabet  stages  of  any  investigation  is  always 
worthless.  The  man  that  is  contented  with  things  as 
they  are  forgets  that  the  world  is  not  yet  completed, 
but  is  always  completing,  and  only  the  elect  ride  on  the 
latest  wave,  because  perpetual  modernness  is  the 
measure  of  merit. 

SOME  COMPARATIVE  ADVANTAGES. 

Two  hundred  cases  can  be  kept  under  way  all  the 
time,  thereby  catching  the  rhythm  of  that  sweet  old 
legend,  "the  greatest  good  to  the  greater  number." 

A  large  number  of  people  adopt  these  ideas,  that 
would  never  subject  themselves  to  other  methods. 

As  the  surface  of  a  hemorrhoidal  tumor  is  never 
broken  there  is  no  such  thing  as  post-operative  hem- 
orrhage. 

A  skillful  application  of  this  system  leaves  pain  out 
of  the  experience  and  patients  can  attend  to  their  usual 
affairs. 

A  case  thoroughly  restored  is  permanent;  but  if  it 
had  to  be  treated  every  year,  the  advantages  would 
still  exist. 

Any  substance  injected  into  animal  tissue  travels  in 
the  direction  of  the  least  resistance;  hence,  in  these 
matters,  it  does  not  invade  deeper  relations  to  their 
detriment. 

The  general  health  improves  from  the  first  day. 

There  is  only  one  disadvantage,  under  this  head,  and 
that  is,  it  takes  so  much  experience  to  become  skillful ; 

13 


whereas,  in  other  systems  there  are  no  complex  ideas. 
Every  case  is  simply  a  case,  and  awakens  nothing 
different. 

The  greatest  advantage  of  this  interstitial  invasion, 
as  a  means  of  destroying  hemorrhoids,  is  that  there  are 
no  disadvantages. 

Prolapsus,  involving  the  mucous  membrane  and  sub- 
mucous tissue,  is  a  condition  that  is  quite  versatile  in 
disturbing  the  general  health  and  disposition.  At  every 
movement  all  the  inner  coatings  seemingly  slip  from 
their  normal  relations,  traveling  out  into  the  outer 
world,  where  they  are  grasped  by  the  sphincter  muscle, 
engendering  a  vast  amount  of  sickening  anguish  and 
irritable  humor.  Whenever  the  muscle  has  lost  its 
usual  degree  of  integrity  then  the  entire  affair  comes 
down  at  any  time,  irrespective  of  place  or  occasion, 
when  the  patient  becomes  burdened  with  a  busy  experi- 
ence, that  lends  everything  but  joy  to  the  complexity 
of  his  feelings. 

Coincident  with  this  experience  the  sympathetic 
nervous  system  is  lashed  into  greater  activity,  the 
excess  of  combustion  causing  a  rapidity  of  existence  to 
the  extent  of  about  a  dozen  days  for  every  week,  hence 
that  perennial  enervation.  Gather  up — in  sections — 
into  the  fenestrum  of  a  speculum,  all  of  that  relaxed 
tissue,  and  inject  a  5  per  cent,  solution  of  carbolic 
acid,  just  enough  to  get  a  gentle  distribution,  without 
commotion,  and  a  general  atrophy  will  result,  tighten- 
ing the  entire  rectum  to  such  an  extent  that  the  func- 
tion will  be  restored  to  original  behavior.  Perhaps 
there  is  nothing  in  the  range  of  this  specialty  that 
will  command  more  gratitude  than  to  take  a  relaxed 
rectum  and  return  it  to  perfection,  unloading  a  cata- 
logue of  burdens  that  have  weighed  heavily  upon 
every  nerve  center  in  the  economy  of  all  such  sufferers. 

Pruritus  is  one  of  the  most  rebellious  conditions  we 
meet,  and  no  one  can  say  just  what  the  outcome  is 

U 


going  to  be  in  any  given  case.  I  never  promise  any- 
thing, but  find  the  most  satisfactory  results  from  the 
following  application,  used  in  connection  with  a  20 
per  cent,  solution  of  fluid  hydrastis  injected  into  the 
rectum  twice  daily  and  allowed  to  remain : 

Acid  carbolic grs.  xxx. 

Calomel dr.  i. 

Tar  dr.  iss. 

Menthol    gr.  xx. 

Zinc  oxide dr.  ii. 

Lanoline oz.  ii. 

Rub  actively  into  the  skin  twice  daily  after  bathing 
with  hot  water. 

I  always  detested  the  idea  of  flashing  any  personal 
lime-light,  but  it  is  orthodox  to  battle  facts  against 
fancy;  so  I  am  constrained  to  say  that  I  have  a  repu- 
tation, ever  stretching  in  its  radius,  that  has  been  de- 
veloped on  account  of  the  above  apparently  simple 
ideas,  being  moulded  into  correct  affinities  and  cor- 
rectly applied.  There  is  a  minute  minority  of  the 
medical  profession  permanently  sold  to  unbelief,  that  I 
fain  would  incite  to  some  interest  in  this  question;  so 
if  they  will  come  with  me  out  into  the  open  of  my 
accumulated  occurrences  I  will  try  and  unpack  reason 
with  deeds,  showing  them  the  living  evidence  from 
which  we  have  drawn  this  abbreviated  farrago. 

MAKING  AN  EGOTISM  OF  IGNORANCE. 

A  distinguished  member  of  the  Academy  of  Medi- 
cine recently  read  a  very  interesting  paper,  describing 
the  various  methods  of  destroying  hemorrhoids.  After 
discoursing  most  learnedly  as  to  the  many  devices  re- 
lating to  this  condition,  he  reached  the  highest  fervor 
of  his  effort  by  saying  "  he  did  not  know  anything 
about  the  interstitial  invasion,  and  did  not  want  to." 
Even  if  this  gentleman  does  confess  he  is  devoid  of 

15 


all  knowledge  regarding  the  beneficial  quality  of  this 
particular  practice,  I  happen  to  be  in  a  position  to  tell 
him,  from  information  that  comes  to  me  guarded  by 
the  most  conservative  judgment,  that  there  are  about 
thirty  thousand  people  in  this  city  that  do  know  all 
about  it,  and  are  eloquently  recommending  this  plan 
every  day,  people  that  have  their  reasons  from  personal 
experiences,  and  form  the  texture  of  a  reputation  that 
expresses  such  a  volume  of  appreciation  that  it  would 
be  quite  difficult  to  duplicate  it. 

A  man's  reputation  is  always  measured  by  the  humor 
of  those  with  whom  he  has  done  business,  and  not  by 
the  compliments  of  his  competitors. 

About  thirty  years  ago  the  Western  Union  Tele- 
graph Company  used  these  very  same  words :  "We 
don't  know  anything  about  it  and  don't  want  to."  This 
occurred  when  the  new-born  telephone  knocked  at  its 
threshold,  pleading  for  recognition  and  opportunity. 
Every  one  knows  the  subsequent  history.  Within  a 
much  smaller  magnitude,  but  involving  a  more  vital 
question — the  conservation  of  human  life,  the  very 
same  kind  of  experience  has  been  duplicated  for  those 
able  gentlemen  that  thrive  upon  the  practice  of  this 
specialty,  have  been  omitted  by  hundreds  and  hundreds 
of  afflicted  people,  just  because  they  did  not  open  their 
minds  wide  enough  and  long  enough  to  grasp  the  full 
meaning  that  embellishes  the  simplicity  of  this  im- 
portant subject. 

"Success  requires  not  something  new 
To  win  applause  and  recognition; 
But  doing  that  which  others  do 
Beyond  their  range  of  competition.' 

What  could  be  more  scientific,  more  in  harmony  with 
practical  uncommon  sense,  more  happy  as  a  response 
to  the  solicitations  of  a  suffering  people,  than  to  meet 

16 


every  case  that  brings  an  array  of  hemorrhoidal  tumors 
as  a  burden  of  complaint,  with  an  easy  application  of 
this  idea,  by  sending  a  lo  per  cent,  solution  of  carbolic 
acid  all  through  the  structural  tissue  of  each  growth, 
but  only  one  at  a  time.  The  chaste  affinity  that  this 
medicine  has  for  such  vascular  creations,  simply  neu- 
tralizes their  nourishment,  and  as  an  inevitable  conse- 
quence the  whole  volume  affected  is  carried  away 
within  a  reasonable  time,  leaving  a  thoroughfare  free 
of  every  indication  as  to  what  had  gone  before.  Behind 
this  brief  outline,  there  must  exist  of  course,  a  master 
of  detail,  trained  by  long  experience  to  execute  all 
those  delicate  and  necessary  manoeuvres,  in  order  to 
attain  the  full  fruition  of  this  proceeding,  for  discord 
was  never  known  to  lead  up  to  harmony,  though  all 
adverse  criticisms  that  have  been  written  or  spoken 
upon  this  subject  can  be  traced  to  discord  in  execution. 
In  the  further  employment  of  this  system  there  is  that 
enervating  condition  where  the  mucous  membrane  and 
some  sub-mucous  tissue  is  always  so  willing  to  travel 
along  with  the  slightest  extrusive  energy,  seemingly 
lost  as  to  all  organic  anchorage,  even  sliding  out  into 
the  open  world,  frequently  requiring  forcible  readjust- 
ment, much  to  the  mental  and  physical  disturbance  of 
the  individual. 

Every  physician  knows  what  a  burden  this  is  upon 
the  general  health,  how  every  vital  function  is  apt  to 
be  extensively  involved,  just  because  the  law  of  reflex 
action  finds  here  such  a  rich  opportunity  for  its  versa- 
tile and  pernicious  activity.  Unless  the  greatest  care 
is  exercised  this  symptomatic  picture  may  be  easily 
mistaken  for  the  true  details  of  a  well  defined  reality, 
so  vivid  and  so  graphic  are  the  simulating  messages 
that  are  constantly  being  distributed  from  the  active 
warfare  at  the  peripheries.  By  introducing  a  tubular 
speculum,  this  relaxed  tissue  can  be  profusely  strained 
into  the  fenestrum,  showing  a  billowy  roll  of  irresolute 

17 


mucous  membrane  apparently  without  any  avocation, 
or  any  other  means  of  support.  Into  this  mass  inject 
the  solution  above  mentioned,  until  there  is  a  general 
diffusion  all  through  the  entire  volume,  holding  the 
speculum  in  position  for  about  one  minute,  so  as  its 
constriction  will  retain  the  medicine  within  the  mass 
involved  until  it  becomes  fixed  by  virtue  of  its  natural 
affinity.  By  repeating  this  every  several  days,  until 
the  entire  territory  at  fault  comes  under  this  specific 
influence,  there  will  ensue  a  general  atrophy  of  the 
entire  rectum,  tightening  it  up  as  it  were,  and  bringing 
the  wayward  function  back  to  a  normal  behavior. 

Then  there  is  that  condition  of  recurrent  hemorrhage 
that  appears  without  any  other  symptom  or  complica- 
tion, losing  a  sufficient  amount  of  blood  to  diminish 
the  entire  vitality  very  much,  according  to  the  tem- 
perament of  the  individual  affected.  By  drawing  back 
the  slide  after  the  speculum  has  been  thoroughly  intro- 
duced, the  hemorrhagic  surface  comes  into  easy  view, 
showing  an  uncovered  area  that  allows  the  blood  to 
escape,  as  the  daily  function  comes  along  with  its 
volume  of  unresisting  pressure.  Just  let  some  of  the 
same  solution  flow  into  this  insinuated  tissue  by  means 
of  a  hypodermic  machine,  when  the  circulation  there 
becomes  coagulated  at  once,  sealing  up  forever  the 
open  door  of  depletion,  locked  by  the  skillful  gesture 
of  a  simple  practical  thought.  To  perform  the  White- 
head operation  for  such  an  affair — as  is  being  fre- 
quently done — would  be  like  using  a  sledge  hammer 
to  break  a  butterfly.  These  little  catches  from  a  life 
work  along  this  line  are  only  hints  as  to  what  has  been 
done,  and  can  be  done,  and  are  given  as  something 
tangible,  in  answer  to  the  nothingness  of  an  open  con- 
fession that  admits  an  absolute  lack  of  information  on 
this  subject.  I  have  myself  seen  a  great  many  thou- 
sands restored  to  health  by  this  method,  and  they  can 
be  found  close  together  all  through  this  city,  as  well 

18 


as  in  every  city  in  the  country,  including  every  city  in 
Europe,  all  coming  here  in  response  to  a  reputation 
that  lives  up  to  the  better  v^ay.  To  neutralize  this 
growing  influence  by  the  play  of  just  one  negative 
sentence,  would  be  as  impossible  as  going  out  to 
Wilkesbarre  for  the  purpose  of  destroying  one  of  the 
greatest  industries  in  existence  by  waving  a  little  flag 
of  hostility  against  the  boundless  commerce  in  coal. 
The  eminent  practitioner  whose  peculiar  laconism  gave 
creation  to  these  meagre  and  modest  lines,  can  not 
surely  object  to  a  few  analytical  sentences  of  criticism, 
inasmuch  as  he  has  openly  endeavored  to  deprecate  the 
character  of  a  well  established  and  fascinating  fact. 
It  has  been  estimated  with  a  considerable  show  of 
accuracy,  that  about  twenty  people  out  of  every  hun- 
dred are  suffering  from  this  malady,  all  looking  for 
release,  but  very  few  willing  to  adopt  any  personal 
attention.  Having  been  intimately  related  to  the 
temperamental  experiences  that  find  such  an  expansive 
currency  in  this  matter,  it  may  not  seem  unreasonable 
to  offer  a  relative  diagram,  approximating  the  disposi- 
tion of  this  specialty,  when  considered  in  the  light  of 
such  influences  as  the  caption  of  this  message  would 
seem  to  imply.  Acting  upon  an  intuition  that  has 
grown  from  personal  observations  extending  over 
thirty  years,  I  feel  I  am  quite  safe  in  estimating  that 
just  one  person  out  of  the  twenty  above  mentioned  is 
willing  to  adopt  any  measure  of  relief  suggested  by 
those  who  have  him  under  jurisdiction,  but  that  two 
people  out  of  the  same  quotation,  hesitate  before  going 
to  such  extremes,  and  begin  to  ask  questions  about 
more  reasonable  and  attractive  means,  shrinking  from 
occupying  the  centre  of  the  stage  in  that  great  popular 
tragedy,  known  as  the  necromancy  of  knives.  The 
remaining  seventeen  refuse  to  have  anything  done  by 
anybody,  depending  upon  such  adventitious  things  as 
come  to  them  from  the  chaos  of  promiscuous  sugges- 
tions. Q 


It  Is  not  very  difficult  to  estimate  the  injury  resulting 
from  a  man  of  high  degree  standing  up  in  his  pulpit  of 
self-sufficiency  and  announcing  by  innuendo,  that  what 
he  does  not  know  is  not  worth  knowing,  even  going 
so  far  as  to  denominate  his  favorite  brand  of  ignorance. 
When  such  a  statement  goes  out  to  the  medical  world 
it  travels  very  fast  indeed,  being  propelled  by  the 
breath  of  prejudice,  while  old-fashioned  truth,  married 
to  time,  journeys  along  very  slowly  in  pursuit,  but 
ultimately  it  always  prevails.  The  general  profession 
is  not  usually  equipped  to  furnish  the  refinement  of 
surgical  means  for  this  i  per  cent,  class  of  sufferers, 
and  having  been  influenced  by  such  messages  as  I 
have  already  repeated,  consequently  the  entire  3  per 
cent,  are  left  helpless  and  neglected,  when  so  many  of 
them  could  be  rescued,  as  they  will  be  when  thoughts 
divorced  from  antiquity  are  generally  distributed  and 
adopted.  Like  a  little  wave  of  retribution,  there  is  a 
humorous  bit  of  history  that  contributes  quite  an 
argument  against  the  feasibility  of  these  antagonisms, 
showing  how  unequal  is  the  equation  when  only  a 
personal  feeling  is  thrown  in  the  balance  against  end- 
less object  lessons  of  a  living  and  expanding  reality. 
Over  and  over  again  has  it  occurred  that  the  family 
physician — that  blessed  oracle  and  Court  of  Appeals 
in  so  many  domestic  consultations,  has  weighted  his 
great  influence  in  opposition  to  modern  means  when- 
ever a  rectal  malady  required  immediate  and  specific 
attention.  I  have  been  made  aware  in  several  hundred 
instances,  that  the  conflict  has  run  so  high,  the  family 
has  taken  the  question  out  of  dispute,  following  their 
own  judgment,  breaking  forever  the  bonds  of  mutual- 
ity, then  making  arrangements  for  a  successor  of  their 
medical  advisor. 

An  established  truth  made  so  by  public  appreciation 
and  support,  can  never  be  driven  back  by  prejudice 
that  has  been  withering  for  over  thirty  years,  until 

30 


now  only  a  remnant  remains,  while  many  physicians 
are  not  only  personal  patients,  but  are  swinging  all 
their  available  influence  in  the  building  up  of  a  system, 
I  am  doubly  assured  by  those  in  a  position  to  know, 
that  prolongs  more  lives  in  this  city  by  dealing  with 
more  cases  than  all  the  other  plans  combined.  To  that 
remaining  minority  whose  feelings  find  friction  in 
dissolving  views — I  would  request  an  audience,  for 
the  purpose  of  suggesting  that  they  place  a  modern 
candle  power  behind  every  window  of  their  souls, 
thereby  yielding  an  exhibition  of  bright  new  light  and 
genial  warmth,  in  place  of  that  perennial  darkness, 
which  so  easily  spreads  thick  shadows  all  over  their 
careworn  faces,  whenever  a  beloved  patron  has  the 
temerity  to  whisper  thoughts  of  innovation.  When  a 
self-appointed  censor  climbs  so  high  in  an  atmosphere 
of  theory,  that  the  rarefied  air  begets  an  incoherency 
of  reasoning  compelling  him  to  improvise  a  hypotheti- 
cal basis  in  the  place  of  mental  equivalents,  he  is  wav- 
ing the  colors  of  the  negative  factor  in  the  great 
progressive  duel  between  ignorance  and  knowledge. 
When  he  breathes  bitterness  against  a  proposition  that 
he  says  he  don't  know  anything  about,  he  is  enacting 
a  behavior  parallel  to  condemning  reputable  citizens 
without  listening  to  any  disapproving  testimony. 

When  he  so  narrows  the  range  of  professional  lib- 
erty, that  every  departure  in  thought  or  action  that 
does  not  bear  his  courteous  stamp  of  approval,  must 
be  considered  as  unpardonable  heresy,  then  he  is  fos- 
tering a  disposition  that  would  just  revel  in  the  disaster 
of  one  case  gone  wrong,  and  draw  the  dusty  curtain 
of  silence  across  the  picture  of  ten  thousand  brilliant 
successes.  When  he  closes  the  avenue  that  might  lead 
to  valuable  acquisitions  of  information,  and  in  the 
spirit  of  being  well  satisfied  with  himself  says  he  don't 
want  to  know  anything  more  upon  a  given  subject, 
knowing  enough  already,   he  may  be  thriving  as   a 

31 


temporary  attraction  of  frenzied  popularity,  but  such 
conduct  never  builds  tablets  in  the  everlasting  Hall  of 
Fame. 

The  man  that  does  things,  and  swings  his  entire  life 
in  the  circle  of  honest  endeavor,  insisting  upon  know- 
ing all  the  possibilities  that  pertain  to  his  personal 
world,  and  never  condemns  except  upon  the  basis  of 
being  qualified  by  investigation,  is  the  man  who  lives 
close  down  to  ancestral  earth,  that  reliable  incubator  of 
all  our  existing  values. 

"You  don't  know  how  much  I  appreciate  what  you 
have  done  for  me.  I  had  been  treated  about  six  years 
and  by  thirty-one  different  surgeons.  Your  generosity 
and  big-heartedness  is  incomparable.  You  make  small 
of  your  wonderful  work  and  your  liberal  and  honest 
treatment  of  your  patients,  but  I  think  you  are  so  far 
ahead  of  all  the  men  I  have  seen  that  I  find  it  impossi- 
ble to  make  your  work  appear  anything  but  great.  I 
enclose  the  check  for  sum  you  intimated  when  I  first 
saw  you.  It  is  so  small  for  the  service  rendered  that 
I  can  not  help  but  feel  ashamed ;  but,  as  you  say,  there 
are  many  things  better  than  money.  I  realize  you 
made  me  special  terms  out  of  the  greatness  of  your 
generous  nature  and  I  appreciate  it  more  than  you 
can  know." 

I  print  the  above  personal  letter  without  apology, 
not  for  the  purpose  of  expanding  my  own  reputation 
• — which  I  don't  need — ^but  to  show  how  the  average 
surgeon  overestimates  the  requisite  necessities  as  to 
rescuing  a  man  from  such  a  condition.  Here  was  an 
army  officer  that  had  contracted  chronic  diarrhoea  in 
the  Philippines,  and  when  I  saw  him  first  found  the 
entire  rectum  one  entire  mass  of  ulceration,  looking 
like  an  old  garment  that  had  been  riddled  by  the  activi- 
ties of  a  million  moths.  About  six  inches  above  the 
sphincter  muscle  was  a  stricture  that  would  not  admit 
a  bougie  only  of  the  smallest  size.     Down  from  this 

22 


constriction  burrowed  an  incomplete  internal  fistula 
that  traveled  back  into  the  lumbar  region,  the  entire 
picture  being  hung  in  an  enervating  frame  of  constant 
pain  and  tenesmus.  It  is  not  my  humor  to  tell  what 
had  been  done  for  him  or  proposed  as  a  last  resort.  I 
only  want  to  describe  the  simple  simplicity  that  made 
him  well,  as  simplicity  is  the  only  broad  and  popular 
religion  of  this  specialty. 

With  a  long,  thin,  small  dilator,  made  for  the  case, 
I  opened  the  rectum  daily  to  the  very  margin  of  dis- 
comfort and  held  it  there  for  one  minute,  first  flushing 
the  entire  capacity  with  an  antiseptic  neutralizing  solu- 
tion. This  left  the  function  in  a  purified  state  and 
robbed  of  a  large  portion  of  its  involuntary  mobility — 
and  there  is  nothing  like  rest  to  restore  such  cases. 
Before  withdrawing  the  machine,  a  good-sized  tampon 
of  dry  cotton  was  introduced  to  the  upper  extremity 
of  the  dilator,  so  as  to  dam  up  in  measure  the  secretions 
that  journey  downward,  thus  insuring  an  approxi- 
mated dryness  and  passivity  of  the  involvement  for 
nearly  twenty  hours.  It  was  gladness  to  watch  those 
confluent  ulcerations  fill  in  with  new  and  normal 
tissue.  And  within  sixty  days  the  entire  fault  was 
gone — including  the  posterior  fistula,  which  had  been 
divided  upon  the  installment  plan  clear  out  to  its 
lumbar  extremity.  During  all  this  attention,  not  one 
day  did  he  lose  from  his  business,  which  is  a  most 
valuable  consideration. 

The  eccentricities  of  fistulous  tracks  forms  one  of 
the  surprises  of  this  specialty.  I  am  going  to  relate  the 
features  of  a  couple  cases  that  would  never  be  met  in 
a  general  practice.  For  twenty-five  years  a  well- 
developed  man  had  been  suffering  with  pains  involving 
the  whole  rectal  neighborhood,  especially  in  lumbar 
region  and  along  the  urethra  up  to  the  left  inguinal 
gland.  Nothing  was  visible  except  the  landmarks  of 
many  hospital  operations,  but  by  the  closest  scrutiny 

23 


I  found  a  small  pinhole  in  the  small  of  the  back,  which 
would  admit  a  slender  probe  for  about  one  inch.  I 
injected  cocaine  into  this  tissue  and  opened  the  track. 
Then  I  found  the  sinus  continued  in  a  circle  of  three 
inches  in  diameter.  Following  this  course  until  it  had 
toured  its  circular  extent,  the  journey  was  continued 
in  a  straight  line  for  eight  inches,  opening  into  the 
posterior  wall  of  the  rectum.  From  this  location  it 
circled  around  the  right  side  to  the  perineum,  then 
following  close  to  the  urethra  up  to  base  of  scrotum, 
when  it  turned  to  the  left  and  ended  in  the  left  inguinal 
gland.  This  entire  tunnel  was  opened  by  dividing  a 
portion  at  a  time,  and  dressing  daily  with  antiseptic 
attention.  In  fifty  days  the  entire  course  was  changed 
into  healthy  tissue ;  he  not  losing  one  day  from 
business,  being  a  city  official.  For  about  three  inches 
of  the  track  opened  the  urethra  was  exposed,  showing 
it  had  laid  in  a  cesspool  of  indolent  ulceration  for  many 
years.  Being  a  man  of  large  stature,  afforded  ample 
chances  for  extensive  lengths,  and  the  sinus  measured 
just  twenty-five  inches  in  its  complete  circuitous  extent. 
Another  man  that  weighed  350  pounds,  furnishing 
great  possibilities  for  these  involvements,  had  an  open- 
ing out  over  the  right  hip  joint,  connecting  with  the 
rectum  by  way  of  a  large  excavation  in  the  centre  of 
its  course,  where  a  good-sized  orange  could  have  been 
sequestered.  Having  been  abandoned  by  every  one 
that  should  have  given  him  relief,  I  was  glad  to  battle 
with  him  for  his  life.  By  opening  the  deep  central 
excavation  an  elastic  ligature  was  adjusted  to  the  outer 
half,  which  divided  that  portion  quite  promptly,  and 
the  entire  condition  was  made  antiseptic  from  the  first 
day  the  awful  chills  caused  by  absorbing  the  poison 
were  discontinued.  In  about  three  weeks  this  section 
was  sufficiently  healed  so  the  remaining  half  could  be 
also  divided  by  ligature.  The  centre  of  the  fistula  was 
just  four  inches  below  the  surface.     In  just  fifty-two 

days  this  case  was  fully  restored. 

24 


"A   ROLLING   STONE    GATHERS   NO   MOSS.' 

E.    F.    HOYT^    M.D. 

I  hate  moss !  and  with  all  my  soul 

I  hate  the  stone  that  will  not  roll; 

But  in  its  bed  of  slothful  ease 

It  gathers   there  by   slow   degrees 

This  useless  garb  of  idle  years. 

No  thoughts,  no  strifes,  no  hopes,  no  fears, 

Unfold  a  life  of  crisp  conceits, 

That  yield  a  lustre,  and  completes 

A  round  of  beneficial  deeds. 

Responsive  to  ambition's  needs. 

As  the  unwinding  wheel  of  time 
Pays  out  the  centuries  sublime. 
And  each  successive  one  reveals 
The  grander  lesson  it  conceals. 
So  onward  goes  a  mighty  world. 
The  God  of  nature  has  unfurled 
The  banner  of  progressive  thought. 
The  subtle  laws  that  He  has  wrought 
Evolving  to  the  human  mind 
In  currents  measured,  and  combined 
With  comprehensive  methods  rare. 
The  race  that  live  to-day  declare 
Achievements  to  the  past  unknown, 
But  still  this  mossy,  carping  stone 
Ignores  the  grandeur  of  the  scene 
Contrasting  with  its  heedless  mien, 
And  chants  that  aphoristic  wail, 
By  countless   ages  rendered   stale, 
Which  pleads  for  favor  and  for  fame 
Upon  that  weak  and  foolish  claim 
Of  having  clogged  its  years  with  dross, 
By  ever  hoarding  worthless  moss. 

I  sing  the  stone  that  dares  to  roll. 
That  superstition   can't  control. 
That  braves   tradition's   haughty  creed, 
And  journeys  on  with  rapid  speed, 
Upsetting  all  dogmatic  whims. 
Whose  stolid  shadow  ever  dims 
The  mental  vision  of  the  age 

25 


With  that  peculiar   quoting  rage 
Adopted  by  the  weary  host 
That  ever  flaunt  some  lingual  ghost 
Into  the  light  of  present  needs, 
To    garnish    thus    their    feeble    deeds. 
The  rolling  stone  encounters  then, 
Every  shade  and  class  of  men; 
Observes  the  spirit  of  their  lives, 
And  ever  watchful,  it  contrives 
To  glean  the  substance,  and  regale 
Its   bright   career   with   such   detail 
Of  enterprising  thoughts,  that  lead 
To  broader  aims,  and  supercede 
The  withered  yearnings  of  the  stone 
That  only  pleads  to  be  alone. 

To  catalogue  the  human  race, 
And  designate  by  trait  and  place, 
The  current  attributes  of  life 
Outflowered   by   aggressive   strife. 
Commands  attention  to  the  grade 
Attained  by  human  nature's  trade, 
When  moulding  on  that  narrow  plan 
The  form  and  semblance  of  a  man. 
Whose  meagre  soul  is  ever  prone 
To  t3^ify  the  idle  stone. 
The  highway  of  his  true  domain, 
Where  walk  the  pigmies  of  his  brain, 
Lead  not  among  the  fragrant  fields 
Of  cultured  minds  and  grand  ideals, 
But  circles  in  a  smaller  sphere 
The  confines  of  his  whole  career. 
Enclosed  within  this  petty  realm. 
He  vainly  thinks  he  holds  the  helm 
That  sets  the  course  of  mighty  deeds 
And  guides  the  judgment  that  succeeds. 
His  shriveled  nature  is  replete 
With  all  the  forms  of  mean  conceit. 
And  when  his  little  mind  is  sought 
To  harmonize  with  broader  thought, 
He  shrinks  away  from  easy  view. 
Abhorring  all  things  that  are  new. 
Unless  they  bear  the  stamp  and  creed 
Of  a  sluggish  heart  and  selfish  greed. 

20 


No  softening  showers  of  heavenly  grace 
Can  melt  the  hardness  from  his  face; 
The  nectar  that  the  gods  do  quaff 
Could  ne'er  subdue  his  vulgar  laugh; 
No  magic  minds  could  e'er  impart 
A  single  impulse  to  his  heart; 
No  joyous  scenes,  with  gladness  fraught, 
Can  kindle  there  a  warmer  thought; 
No  soothing  words,  however  choice. 
Can  take  the  harshness  from  his  voice; 
His  little  life's-enacting  role 
Echoes  the  dryness  of  his  soul; 
But  when  the  sun's  outpouring  light 
Redeems  a  day  from  gloomy  night, 
And  brings  to  view  the  silent  force 
Oppressing  manhood's  only  source, 
'Tis  then  we  know  the  conscious  loss 
Of  being  clogged  with  skeptic  moss. 


27 


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